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Adjunct associate professor, UCLA Fielding School of Public Health, health sciences associate professor of family medicine, UCLA David Geffen School of Medicine, and director, Division of Chronic Disease and Injury Prevention and Office of Senior Health, Los Angeles County Department of Public Health, Los Angeles, California.

Director, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland.

We thank Dr. Carvajal and her colleagues for their letter regarding pay parity for women1 and those underrepresented in medicine2 (URM). We wholeheartedly agree that pay parity is requisite for properly supporting physicians who work with underserved populations. URM faculty have been shown to pay a higher proportion of their earnings to student debt,3 and our findings showed that URM students shoulder disproportionate educational and consumer debt, underscoring the need to eliminate structural and institutional barriers that impede access to quality care.

We posit that women and URM physicians in academic medicine not only accrue more financial debt but also are disproportionately taxed in other ways. In their studies, Rodríguez and colleagues4 eloquently described the extra burdens of the minority tax, and Carapinha and colleagues5 described the effects of discrimination and work–family conflict on the workplace climate for women faculty. While the financial and psychosocial costs on women and URM faculty are high, we highlight the dividends that women and URM faculty also pay. Citing positive factors such as the opportunity to influence the institution; serving as a role model6; and maintaining cultural values such as belonging, connectedness, and giving back7 are just a few ways that URM and women faculty are resilient, can positively influence institutional culture, and are still more likely to work in underserved areas. It’s time these values receive the equitable compensation they deserve.

Adjunct associate professor, UCLA Fielding School of Public Health, health sciences associate professor of family medicine, UCLA David Geffen School of Medicine, and director, Division of Chronic Disease and Injury Prevention and Office of Senior Health, Los Angeles County Department of Public Health, Los Angeles, California.

Eliseo J. Pérez-Stable, MD

Director, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, Maryland.